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November 2016 Member of the Month

Antonio P. Linares, MD, MPH, FAAFP

Antonio P. Linares, MD, FAAFP, is the Regional Vice President and Medical Director for Anthem Blue Cross, providing medical leadership in care management and population-based care, including health promotion strategies for large employers. He previously served as the Vice-President of Medical Affairs for Lumetra, a Centers for Medicare and Medicaid Services (CMS)-Medicare Quality Improvement Organization, at which he directed patient safety initiatives for hospitals in California to meet the CMS-Medicare quality reporting requirements and developed statewide performance improvement projects. Dr. Linares has served in diverse leadership roles during his career, including founding medical director for California’s Department of Managed Health Care, which oversees quality and consumer protection for all health maintenance organization members in California, corporate vice president of medical action planning for CIGNA Healthcare and founding chief medical officer for OSF Health Plans, to name but a few.

Why did you choose family medicine, and what’s your favorite aspect of it?

I was fortunate to receive a National Health Service Corps (NHSC) scholarship to attend Case Western Reserve University (CWRU) School of Medicine, and that put me into a primary care career pathway. Caring for a newborn, the mom, and the family, including home visits, was required at CWRU for first-year medical students interested in family medicine, and I got hooked.

Were you inspired by anyone to pursue family medicine?

Jack Medalie was the Chair of Family Medicine at CWRU and a pioneer in the development of family medicine as a new specialty practice. I took several electives with him and was inspired by his vision of family medicine. He believed that all family docs should be engaged in improving the science of health care in the community, continuity of care in the home setting and providing access to care for at-risk populations.

What is the most interesting/memorable experience you have had when dealing with a patient?

I became interested in diabetes care and cross-cultural medicine during my residency. In my second year of private practice, I saw a 17-year-old Latina who had Type 1 diabetes, was poorly controlled and was under the care of a local endocrinologist who refused to see her again because he said she was “non-compliant.” Her A1C was 22 and she had several poor healing wound ulcerations. Spanish was her primary language, and it became apparent that fear, emotional stress and family dynamics were driving much of her non-adherence. Her mother had died at an early age of complications from Type 1 DM, and her teenage brother also had Type 1 DM and non-adherence. At that time, we did not have access to bi-lingual and bi-cultural diabetes educators. My wife and I had started the first bi-lingual Spanish diabetes education classes in collaboration with Scripps Hospital in Chula Vista, and we enrolled her in bi-weekly classes in which she excelled in all topics of diabetes care. She was an avid learner and enjoyed the exchange with other bi-lingual and bi-cultural patients. After two months, her A1C dropped to eleven and continued to drop while her ulcerations completely healed. A few years later she married and had a healthy pregnancy with excellent diabetes control.

What one word or phrase characterizes your style of family medicine?

What is the best experience you have had during your career as a family physician?

Early in my career, I testified before Congress on the importance of preventive care in family medicine. This was a memorable experience and an opportunity to affect diabetes prevention through health policy implementation.

I was a member of the board of directors for the American Diabetes Association (ADA) in California and chaired the Diversity and Cultural Outreach committee. On behalf of the ADA-CA chapter, I was asked to provide testimony at a Congressional Hearing in Washington, D.C. on the impact of diabetes in the minority community. Congressman Edward Roybal of California was the Chair of the Select Committee on Aging and sponsored the hearings. I used several case studies from my practice, along with current research, to demonstrate that the prevalence of Type 2 DM, and related complications among the Latino population, could be reduced with preventive care measures. When the National Institutes of Health (NIH) director provided his testimony and assured Congress that their clinical trials and research were having a direct impact on improving care in ethnically diverse communities, I stood up and respectfully disagreed with his statement. In the coming years, the NIH increased diabetes program funding for the Centers for Disease Control (CDC) and included “Putting Prevention into Practice” to directly support diabetes care in diverse communities.

Today, one out of three adults (86 million people) may have pre-diabetes, and most are undiagnosed. Up to 30 percent of those with pre-diabetes will develop Type 2 DM within five years. This past year the United States Preventive Services Task Force and CDC determined that changes in diet, activity, and lifestyle resulting in 5-7 percent weight loss can reduce Type 2 DM by 58 percent (Grade B evidence). The CDC has now recommended that Diabetes Prevention Programs (DPP) be covered at 100 percent as preventive care under the Affordable Care Act.

It is important for me to be a member of CAFP and AAFP because:

I enjoy engaging in healthcare policy, especially in the areas of expanding access to primary care and improving quality of care. Both the CAFP and AAFP provide a vehicle for that engagement.

What has been your best experience as a CAFP member? Why?

When I was at Lumetra, I directed a CMS pilot project called Doctor’s Office Quality-Information Technology, or DOQ-IT. The goal was to help physician practices use Electronic Medical Records (EMRs) to submit quality data to CMS and receive additional payment for performance improvement. The CMS grant provided funding for a five-state pilot, and part of my job was to recruit primary care practices in California to participate. CAFP was an excellent partner in collaboration, advocacy, and leadership. AAFP experts consulted on the pilot and have built similar performance improvement programs including the “Practice Transformation Network” and the Transforming Clinical Practice Initiative (TCPi).

The most important resource I find CAFP offers me is:

Practice surveys and learning about different elements of practice, performance improvement, Patient Centered Medical Home resources. It is also good to know that members’ feedback can help CAFP and AAFP and that they will do something with it to improve the practice of family medicine.

How do you make a difference in family medicine and in your community?

I am continuously seeking new ideas or innovations in primary care that can affect the Quadruple Aim: 1) Better care for each person served (improved quality process or outcome); 2) A good patient experience of the care received; 3) More efficient care (lower total cost of service); and 4) Higher physician satisfaction and reward for services provided.

Tell us about a project in which you are involved and why it is important to you:

I am the family medicine physician advisor for two recent continuing medical education (CME) programs developed by our Multi-Cultural Health team at Anthem and approved by the AAFP. The first program is to increase awareness of Lesbian, Gay, Bisexual, Transgender (LGBT) health care needs and creating a more LGBT-friendly practice. The CME is current through 1/2017 at www.anthem.com/LGBT. The goal of the second CME course is to reduce asthma health disparities for African Americans, Latinos and Asians. Implicit bias and social determinants of health continue to drive health disparities. Hispanics and African Americans with asthma are less likely to take daily controllers AND are more likely to visit the emergency room and be hospitalized for asthma-related conditions than non- Hispanic Whites. Asian Americans are more likely to die from asthma than non-Hispanic Whites. The free CME course can be accessed at www.anthem.com/asthma.equity.

What are good qualities&nbsp;a family physician should have?

To be present and in the moment with a high level of engagement, empathy and compassion (regardless of time constraints), laying on of hands or holding someone while providing assurance and understanding and having a high index of suspicion for all potential diagnoses or risks at times of ambiguity.

Do your remember your personal statement from medical school? If so, would you like to share an excerpt?

The summer before I started medical school, I had to submit a personal statement to the NHSC with my career goals and the reason why I wanted to be a primary care physician. I knew there was poor access to primary and specialty care along the U.S.-Mexico border because both my parents have family members in Mexico. In my personal note I said I would seek a clinical practice in the Southwest and work to improve primary care access by establishing primary care clinics along the border. My first NHSC community clinic practice was at the San Ysidro Health Center, also the busiest international border crossing in the world. After three years, I was organizing and providing managed care training to the physicians of 35 other community clinics in the San Diego Council of Community Clinics. They became the first Medicaid managed care network for Community Health Group. I continued to work with the NHSC leadership for several years after completing the Public Health Service practice.

What one sentence of advice would you give to medical students interested in family medicine?

Keep all your practice/career options open and consider the diverse areas of interest in family medicine, including public health and health policy.

How do you spend your free time?

I would enjoy farming, agricultural innovations and advancing environmental conservation.

If you weren’t a doctor, what would you be doing with your career?

I’d either be a United Nations diplomat or working for the Peace Corps, focusing on global system improvement, access to education, women’s rights, human rights and the empowerment of the disadvantaged.

What would your best friend say about you?

Always willing to help out and find solutions to a new problem.

Tell us something fun/unusual about yourself:

I have tested three generations of, and have over 28 million steps, on my Fitbit.

Tell us briefly about your family:

My wife and I live in Sacramento and our son is graduating from medical school next year. We enjoy traveling to scenic communities throughout the Southwest if we can find caregivers for our dog and cat, Rocky and Milo.

Each month, CAFP highlights one outstanding California family physician member who lends their voice, time, talent and resources to strengthen the specialty of family medicine and his or her community. If you would like to share your story or know a family physician colleague who deserves to be recognized for his or her impact or leadership, contact CAFP at 415-345-8667 or cafp@familydocs.org.

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The California Academy of Family Physicians is the only organization solely dedicated to advancing the specialty of family medicine in the state. Since 1948, CAFP has championed the cause of family physicians and their patients.

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Note:The California Academy of Family Physicians cannot answer medical questions, give referrals to specific family physicians or endorse products. Visit the American Board of Family Medicine website to find a board-certified family physician in your area.